Attach_1.pdf

ONE TIME/MULTIPLE ACCESS ROSTER

DATA REQUIRED BY THE PRIVACY ACT OF 1974

PMV2.80PREVIOUS EDITIONS ARE OBSOLETE.USAG-J FORM 1529, JUL 2018

1. INSTRUCTION

AUTHORITY:

PRINCIPAL PURPOSE:

ROUTINE USES:

DISCLOSURE:

DATE OF REQUEST

of Pages

Title 10 U.S.C., Code, Section 3013.

To provide information to officials of the Army responsible for monitoring/controlling visitor's status.

Information is used to record and assign authorized pass numbers to allow authorized visitors onto U.S. Army installations.

Voluntary. Failure to disclose the required information will result in authorized pass numbers not being issued; therefore, causing the applicants to have to meet and escort on and off the installation their visitors.

A "One Time/Multiple Access Roster" is valid for a single group visit for a specific date and time. It is the sole responsibility of the individual sponsor to include all information listed. Processing time can be reduced if each sponsor will take the time to legibly list the required information in both English and Kanji. This roster must be submitted to the Provost Marshal, USAG-J (APAJ-PM-MD-R), within four (4) working days of the proposed visit.

The sponsor's signature services as an acknowledgment the sponsor is aware of his/her individual responsibilities to exercise total control over his/her non -SOFA guests in accordance with the provisions contained in USAG-J Regulation 190-13.

a.

b.

a. TYPED NAME (Last, First MI)

e. DESTINATION/INSTALLATION

h. MULTIPLE ACCESS

EFFECTIVE DATE

f. PURPOSE

i. MULTIPLE ACCESS

EXPIRATION DATE

k. SPONSOR'S SIGNATURE

g. TYPE OF REQUEST

d. TELEPHONE NO.b. RANK c. DUTY TELEPHONE NO.

a. VISIT DAY

NATIONALITY NAME (Last, First MI) ADDRESS & DRIVER'S LICENSE NO. TELEPHONE NO. &

PASSPORT NO.

VEHICLE

PLATE NO.

GATE NO.

d. TOTAL (VEHICLE)c. TOTAL (PERSONNEL)

FROM

b. VISIT TIME

ENGLISH ADDRESS

PASSPORT NO.JAPANESE

TEL

DIRVER'S LICENSE NO.

TO

Page

ONE TIME MULTIPLE

2. SPONSOR INFORMATION & ACCESS DESCRIPTION

3. VISITORS INFORMATION

GATE 1 GATE 3 GATE 4 GATE 5/B

e. AREA(S) TO BE AUTHORIZED

ZAMA SGD SHA YND APC PIER6

GATE NO.

ENGLISH ADDRESS

PASSPORT NO.JAPANESE

TEL

DIRVER'S LICENSE NO.

GATE 1 GATE 3 GATE 4 GATE 5/B

GATE NO.

ENGLISH ADDRESS

PASSPORT NO.JAPANESE

TEL

DIRVER'S LICENSE NO.

GATE 1 GATE 3 GATE 4 GATE 5/B

GATE NO.

ENGLISH ADDRESS

PASSPORT NO.JAPANESE

TEL

DIRVER'S LICENSE NO.

GATE 1 GATE 3 GATE 4 GATE 5/B

GATE NO.

ENGLISH ADDRESS

PASSPORT NO.JAPANESE

TEL

DIRVER'S LICENSE NO.

GATE 1 GATE 3 GATE 4 GATE 5/B

j. SPONSOR'S ORGANIZATION

V2.80

FMO

USAG-J FORM 1529

Takahashi Junichiro

ONE TIME/MULTIPLE ACCESS ROSTER

8 Jun 2018

JUL 2018

ONE TIME/MULTIPLE ACCESS ROSTER

DATA REQUIRED BY THE PRIVACY ACT OF 1974

PM

V2.80

PREVIOUS EDITIONS ARE OBSOLETE.

USAG-J FORM 1529, JUL 2018

1. INSTRUCTION

AUTHORITY: PRINCIPAL PURPOSE: ROUTINE USES: DISCLOSURE:

DATE OF REQUEST

of Pages Title 10 U.S.C., Code, Section 3013.

To provide information to officials of the Army responsible for monitoring/controlling visitor's status.

Information is used to record and assign authorized pass numbers to allow authorized visitors onto U.S. Army installations.

Voluntary. Failure to disclose the required information will result in authorized pass numbers not being issued; therefore, causing the applicants to have to meet and escort on and off the installation their visitors.

A "One Time/Multiple Access Roster" is valid for a single group visit for a specific date and time. It is the sole responsibility of the individual sponsor to include all information listed. Processing time can be reduced if each sponsor will take the time to legibly list the required information in both English and Kanji. This roster must be submitted to the Provost Marshal, USAG-J (APAJ-PM-MD-R), within four (4) working days of the proposed visit.

The sponsor's signature services as an acknowledgment the sponsor is aware of his/her individual responsibilities to exercise total control over his/her non -SOFA guests in accordance with the provisions contained in USAG-J Regulation 190-13.

a.

b.

a. TYPED NAME (Last, First MI)

e. DESTINATION/INSTALLATION

h. MULTIPLE ACCESS EFFECTIVE DATE

f. PURPOSE

i. MULTIPLE ACCESS EXPIRATION DATE

k. SPONSOR'S SIGNATURE

g. TYPE OF REQUEST

d. TELEPHONE NO.

b. RANK

c. DUTY TELEPHONE NO.

a. VISIT DAY

NATIONALITY

NAME (Last, First MI)

ADDRESS & DRIVER'S LICENSE NO.

TELEPHONE NO. &

PASSPORT NO.

VEHICLE PLATE NO.

GATE NO.

d. TOTAL (VEHICLE)

c. TOTAL (PERSONNEL)

FROM

b. VISIT TIME

ENGLISH

ADDRESS

PASSPORT NO.

JAPANESE

TEL

DIRVER'S LICENSE NO.

TO

Page

2. SPONSOR INFORMATION & ACCESS DESCRIPTION

3. VISITORS INFORMATION

e. AREA(S) TO BE AUTHORIZED

GATE NO.

ENGLISH

ADDRESS

PASSPORT NO.

JAPANESE

TEL

DIRVER'S LICENSE NO.

GATE NO.

ENGLISH

ADDRESS

PASSPORT NO.

JAPANESE

TEL

DIRVER'S LICENSE NO.

GATE NO.

ENGLISH

ADDRESS

PASSPORT NO.

JAPANESE

TEL

DIRVER'S LICENSE NO.

GATE NO.

ENGLISH

ADDRESS

PASSPORT NO.

JAPANESE

TEL

DIRVER'S LICENSE NO.

j. SPONSOR'S ORGANIZATION